A New Modified Evans Blue Dye Test as Screening Test for Aspiration in Tracheostomized Patients

Abstract

Objective: The authors assessed the diagnostic accuracy of a new modified Evans blue dye test (MEBDT) as a screening test for aspiration in tracheostomized patients.

Design: Monocentric retrospective study performed between October 2013 and December 2015.

Setting: Anesthesia and Intensive Care Unit, Second University of Naples.

Participants: Among 62 eligible patients, 5 were excluded. The authors' study population included 57 patients.

Interventions: Patients underwent both fiberoptic endoscopic examination of the swallow (FEES) and MEBDT to evaluate swallow. The MEBDT results were compared with those of FEES and the diagnostic accuracy of MEBDT was calculated using the FEES as the gold standard.

Measurements and main results: The authors found that both FEES and MEBDT were positive for aspiration in 40 patients (true-positive MEBDT); FEES and MEBDT were negative in 10 (true-negative MEBDT). On the other hand, FEES was positive with an MEBDT negative in 7 patients (false-negative MEBDT), and there were no FEES negative and MEBDT positive (false-positive MEBDT). MEBDT had a sensitivity, specificity, positive, and negative predicted value of 85%, 100%, 100%, and 58.82%, respectively.

Conclusions: MEBDT could be a supplementary diagnostic test for aspiration. Patients with positive MEBDT should not undergo oral feeding, while patients with negative MEBDT should undergo FEES before starting oral feeding.

Keywords: fiberoptic endoscopic examination of the swallow; modified Evans blue dye test; tracheostomy.